CIWA-Ar for Alcohol Withdrawal
Attempts to objectify the severity of alcohol withdrawal and help direct level of treatment.
Supportive care; reassess per protocol
Original author(s)
John T. Sullivan and colleagues (Addiction Research Foundation, Toronto), who revised the earlier CIWA-A into the shorter CIWA-Ar. Placeholder — verify
Original study
Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Br J Addiction. 1989;84(11):1353–1357. Placeholder — verify PMID
Validating studies
Symptom-triggered dosing driven by CIWA-Ar has been shown to reduce benzodiazepine use and treatment duration versus fixed-schedule dosing (e.g., Saitz et al., JAMA 1994; Daeppen et al., Arch Intern Med 2002). Placeholder — confirm citations
When to use
Awake, communicative patients in alcohol withdrawal, to titrate symptom-triggered benzodiazepines and decide level of care. Re-score at intervals (often q1h until stable) — the trend guides dosing. Placeholder — red-pen
When NOT to use
Unreliable when the patient can't participate (intubated, aphasic, severe dementia, profound delirium) — a paralysed patient scores low while withdrawing dangerously. Concurrent illness (sepsis, GI bleed, other withdrawal/intoxication) confounds it. It measures severity, not the diagnosis. Placeholder — red-pen
Our take — why check the score here
The reassessment view is the point: withdrawal is a moving target, so every reading becomes a tab and each symptom carries its own trend, with the total change since the first read front-and-centre — you see the direction, not just the latest number. Our angle vs. a bare calculator: when symptom-triggered breaks down (need for phenobarbital/adjuncts, the RASS-vs-CIWA debate) and a link to the alcohol-withdrawal management page. Placeholder — this is the section that beats MDCalc; red-pen the voice